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Biomedical subjects

K Jules-Elysee

Publications and source records attributed to K Jules-Elysee.

6 recordsLinked to original sources
PubMed2001

Troponin I as a diagnostic marker of a perioperative myocardial infarction in the orthopedic population.

STUDY OBJECTIVE: To assess the utility of troponin I, the only molecular marker of myocardial injury not expressed in regenerating muscle, in diagnosing perioperative myocardial infarction (MI) in the setting of orthopedic surgery where false elevations in creatine kinase MB isoenzymes (CKMB) are known to occur. DESIGN: Prospective study. SETTING: University-affiliated hospital. PATIENTS: 85 patients with risk factors for coronary artery disease (CAD) who were scheduled for orthopedic surgery, including total knee arthroplasty, 34; total hip arthroplasty, 36; posterior spine fusion, 7; and other orthopedic operations, 8. INTERVENTIONS: Patients were observed in the postanesthesia care unit for at least 24 hours where they had an electrocardiogram (ECG) performed, and blood drawn to rule out MI. MEASUREMENTS: Blood samples for measurement of creatine kinase MB isoenzymes (CKMB) and troponin I were drawn at 8-hour intervals for up to 24 hours. MAIN RESULTS: Five (5/85) patients had elevated levels of both CKMB and troponin I postoperatively. New ECG abnormalities were present in all but one patient who had an old anterolateral MI. Troponin I peaked within 16 hours except in one patient where it continued to increase. That female patient developed cardiogenic pulmonary edema. All the others did well clinically. Six patients (6/85) had a positive CKMB index, and a negative troponin I level. None had ECG changes, except for one in whom subsequent cardiac catheterization showed insignificant CAD. They all did well clinically. All patients with an elevated troponin I level had a positive CKMB index. CONCLUSIONS: Troponin I is as sensitive a marker of MI as CKMB in the orthopedic population, but it has a higher specificity in the perioperative setting. Troponin I can be helpful in properly identifying the source of CKMB elevation postoperatively when this elevation is questionable.

Aged↗
PubMed1994

Lung transplantation for chemotherapy-induced pulmonary fibrosis.

A 26-year-old man cured of childhood acute lymphoblastic leukemia underwent a single lung transplant for drug-induced pulmonary toxicity 9 years after the completion of chemotherapy. It is not known whether patients cured of a malignancy who undergo organ transplantation are at increased risk of malignancy as compared to other organ transplant recipients. There was no evidence of recurrent or secondary malignancy in this case. Since single lung transplantation has been effective for idiopathic pulmonary fibrosis, it should be considered for patients cured of a malignancy who develop chemotherapy-induced pulmonary fibrosis.

Adult↗
PubMed1992

Pulmonary complications in lymphoma patients treated with high-dose therapy autologous bone marrow transplantation.

To define the incidence and spectrum of pulmonary complications following autologous bone marrow transplantation (BMT), we retrospectively reviewed the course of 77 consecutive patients with Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) who failed conventional therapy and underwent autologous BMT. Forty-five percent of the 77 patients developed respiratory complications with a mortality from pulmonary causes of 26%. A total of 38 episodes of respiratory compromise occurred in 35 patients. Infections accounted for 15 episodes (39%) and included bacterial (16%), Aspergillus (8%) cytomegalovirus (8%), Herpes simplex (3%), and other (5%) pneumonias. The spectrum of infections was similar to that reported following allogeneic BMT, but cytomegalovirus pneumonia was not as frequent a problem in those with autologous transplant. Mortality from pulmonary infections was 33%. Noninfectious disorders accounted for 23 episodes (61%) and included recurrent HD (18%), radiation/drug toxicity (16%), and acute respiratory failure thought secondary to pulmonary alveolar hemorrhage (26%). This latter entity developed acutely within 2 wk following BMT and was associated with use of thoracic radiation for treatment of malignant disease in the chest just prior to BMT (p < 0.05). It was not associated with the age of the patient or presence of thrombocytopenia, coagulopathy, renal insufficiency or neutropenia (p NS). Mortality from noninfectious causes was 65%, but in those with pulmonary hemorrhage it was 100%. In conclusion, pulmonary complications are a major source of morbidity and mortality in patients with HD and NHL undergoing autologous BMT.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Bleomycin-induced pulmonary toxicity.

Bleomycin is recognized to cause an interstitial pneumonitis that can lead to fibrosis. Although its occurrence may be sporadic, some factors may increase the risk of such a pulmonary reaction. In this article the clinical setting and presentation, radiographic manifestations, pathologic findings, and the prognosis of bleomycin-induced interstitial fibrosis are described. Additionally, the role of pulmonary function tests in monitoring patients for toxicity is discussed.

Adult↗
PubMed1988

Cytomegalovirus pneumonia after bone marrow transplantation successfully treated with the combination of ganciclovir and high-dose intravenous immune globulin.

STUDY OBJECTIVE: To assess the efficacy of the combination of the antiviral agent ganciclovir (9-1,3 dihydroxy-2-propoxymethylguanine) and high-dose intravenous immune globulin for treating cytomegalovirus interstitial pneumonitis after allogeneic bone marrow transplantation. DESIGN: Nonrandomized prospective trial of combined treatment with two drugs; findings in these patients were compared with those in control patients treated with either of the two drugs alone. SETTING: Medical, pediatric, and intensive care units of a tertiary-care cancer treatment center. PATIENTS: Consecutive cases of 10 patients in the study group and of 11 patients in a historical control group with evidence of cytomegalovirus pneumonia after bone marrow transplantation for treatment of leukemia or congenital immune deficiency. INTERVENTIONS: Study Group (10 patients): ganciclovir, 2.5 mg/kg body weight, three times daily for 20 days, plus intravenous immune globulin, 500 mg/kg every other day for ten doses. Patients were then given ganciclovir, 5 mg/kg.d three to five times a week for 20 more doses, and intravenous immune globulin, 500 mg/kg twice a week for 8 more doses. Control Group (11 patients): ganciclovir alone (2 patients), 5 mg/kg twice a day for 14 to 21 days; cytomegalovirus hyperimmune globulin (5 patients), 400 mg/kg.d for 10 days; and intravenous immune globulin (4 patients), 400 mg/kg.d for 10 days. MEASUREMENTS AND MAIN RESULTS: Responses were observed in all patients treated with combination therapy; 7 of 10 patients were alive and well, and had no recurrence of disease at a median of 10 months after therapy. No therapeutic benefit was observed, and none of the 11 patients treated with either ganciclovir or intravenous immune globulin alone survived (P = 0.001 by Fisher exact test). CONCLUSIONS: Ganciclovir, when combined with high-dose intravenous immune globulin, appears to have significantly altered the outcome of patients with cytomegalovirus pneumonia after allogeneic bone marrow transplantation.

Acyclovir↗